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Complete the following form to pre-register for the
2008 Conference in Winston-Salem.

  • Are you currently a NCSFA Member? Yes No
  • Name of Registrant


  • E-mail Address


  • Fire Department


  • Shipping Address (to receive package from NCSFA)


  • City


  • State


  • Zip


  • Phone Number (if we have any issues with your order)


    List Names of Registrants as They Should Appear on
    Conference Badges:

  • Name 1:
  • Name 2:
  • Name 3:
  • Name 4:
  • Name 5:
  • Name 6:

    Spouses and children are permitted in vendor spaces when
    accompanied by a registered attendee. List the names of
    spouses and children here:

    Indicate quantities needed:
      
    NCSFA Member Advanced Registration - $50.00
     
       Guests of Members - $10.00 Each
     
    Non-Member Advanced Registration - $70.00
     
    Banquet Tickets - $30.00 Each

    NCSFA accepts Master Card and Visa

  • Name on Card


  • Credit Card Number (do not include dashes or spaces)


  • Expiration Date
     

  • Credit Card Billing Address Zip Code (for verification)


    Additional Comments (additional badge names needed,
    alternative shipping addresses, etc.):



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